Which of the following risk factors shows the strongest population attributable risk (PAR) for cardiovascular disease in India?

Explanation

## Population Attributable Risk for CVD in India **Key Point:** High systolic blood pressure (hypertension) has the highest population attributable risk (PAR) for cardiovascular disease in India, contributing to approximately 20–25% of the CVD burden. ### Understanding Population Attributable Risk Population Attributable Risk (PAR) combines both the strength of association (relative risk) and the prevalence of the risk factor in the population: $$PAR = P(RR - 1) / [P(RR - 1) + 1]$$ Where P = prevalence of the risk factor, RR = relative risk ### PAR Ranking for CVD Risk Factors in India | Risk Factor | PAR (%) | Prevalence | Relative Risk | |-------------|---------|-----------|----------------| | High SBP | 20–25% | High (30–40%) | Moderate–High | | Physical inactivity | 15–18% | Very high (>50%) | Moderate | | High LDL cholesterol | 12–15% | Moderate (25–30%) | High | | Smoking | 10–12% | Moderate (20–25%) | Very high | | Diabetes | 8–10% | Rising (8–10%) | High | **High-Yield:** Hypertension has the highest PAR because it combines a high prevalence in the Indian population (~30–40% in urban areas) with a strong dose-response relationship with CVD events. **Mnemonic: HAPLC** — High blood pressure has Attributable Population Largest Contribution in India ### Why High SBP Has the Highest PAR 1. **Prevalence:** Hypertension affects 30–40% of urban Indians and 10–15% of rural Indians 2. **Dose-response:** Every 20 mmHg increase in SBP above 115 mmHg doubles CVD risk 3. **Population impact:** Even modest elevations in SBP across the population cause significant disease burden 4. **Modifiability:** Unlike age or sex, hypertension is preventable and treatable, making PAR clinically relevant **Clinical Pearl:** Although smoking has a higher relative risk for individual smokers, its lower prevalence in the general population (compared to hypertension) results in a lower PAR. This is why population-level CVD prevention in India prioritizes blood pressure control over smoking cessation alone.